Cigarette Smoking Among Adults -- United States, 1992, and
Changes in the Definition of Current Cigarette Smoking

Use of tobacco in the United States is monitored continually
by CDC to evaluate efforts to control and prevent the use of this
substance. The prevalence of cigarette smoking among U.S. adults
decreased from 1965 to 1990 (from 42.4% to 25.5%) and remained
stable from 1990 to 1991 (from 25.5% to 25.6%) (1). To determine
the prevalence of smoking among adults during 1992, the National
Health Interview Survey-Cancer Control and Epidemiology Supplements
(NHIS-CCES) collected self-reported information on cigarette
smoking from a random sample of civilian, noninstitutionalized
adults aged greater than or equal to 18 years. For 1992, the
definition used to assess self-reported smoking prevalence was
changed to more accurately assess some-day (i.e., intermittent)
smoking because of a recognized higher prevalence of intermittent
smoking (2). This report presents the prevalence estimates for
1992, compares findings with 1991, and assesses the impact of
changes in the definition of current smoker on these estimates.

The overall response rate for the 1992 NHIS-CCES (n=24,040)
was 86.5%. For 1992, two nationally representative random samples
from the NHIS-CCES were used to assess the new definition of
current smoking status that included intermittent smoking. The
Cancer Control Supplement (CCS) (n=12,035) asked, "Have you smoked
at least 100 cigarettes in your entire life?" and "Do you smoke
cigarettes now?" Persons who said they did not smoke now were
asked, "Do you now smoke cigarettes not at all or some days?"
Current smokers were defined as those who had smoked 100 cigarettes
and smoked now; persons who said they did not smoke now but
subsequently stated they smoked on some days were also classified
as current smokers. The Cancer Epidemiology Supplement (CES)
(n=12,005) asked, "Have you smoked at least 100 cigarettes in your
entire life?" and "Do you now smoke cigarettes every day, some days
or not at all?" Current smokers were defined as those who had
smoked 100 cigarettes and now smoked either every day or some days.
Data were adjusted for nonresponse and weighted to provide national
estimates. Confidence intervals (CIs) were calculated using
standard errors generated by the Software for Survey Data Analysis
(SUDAAN) (3).

Because the first two questions were the same for the 1991
NHIS-Health Promotion and Disease Prevention supplement and the
1992 CCS, these findings were compared directly. The overall
prevalence of cigarette smoking among adults (25.6%) was the same
in 1991 and 1992 (Table_1). The 1992 estimates that
incorporated
some-day smoking (CCS and CES) also were compared with 1991 and
1992 estimates based on the original definition. Estimates for both
sets of definitions that incorporated an assessment of some-day
smoking in 1992 were similar (CCS=26.7% and CES=26.3%)
(Table_1).
Because of the comparability of methods (i.e., assessing some-day
smoking), results were combined to provide an overall prevalence
estimate for 1992. Based on the inclusion of intermittent smoking,
the prevalence of smoking increased by 0.9% (from 25.6% to 26.5%)
(Table_1).

In 1992, an estimated 48 million (26.5% {95% CI=plus or minus
0.5%}) adults in the United States were current smokers, reflecting
prevalences of daily smoking of 22.1% (95% CI=plus or minus 0.5%)
and some-day smoking of 4.4% (95% CI=plus or minus 0.2%). Smoking
prevalence was highest among persons aged 25-44 years (30.8% {95%
CI=plus or minus 0.8%}). Smoking prevalence was highest among
American Indians/Alaskan Natives (39.4% {95% CI=plus or minus
6.0%}) and lowest among Asians/Pacific Islanders (15.2% {95% CI=
plus or minus 3.6%}), declined with increasing levels of education,
and was highest among persons who lived below the poverty level *
(34.9% {95% CI=plus or minus 1.5%}). Approximately 25 million men
(28.6% {95% CI=plus or minus 0.8%}) and 23 million women (24.6%
{95% CI=plus or minus 0.7%}) were current smokers (Table_2).
For
most demographic groups, smoking prevalence was higher among men
than women.

Using the original definition of current smoking, smoking
prevalence was the same in 1991 and 1992 overall, for both men and
women, for all racial/ethnic groups, for all educational levels,
and for persons with incomes above the poverty level (Table_1).
Smoking prevalence was significantly higher in 1992 (37.0% {95% CI=
plus or minus 2.1%}) than in 1991 (33.1% {95% CI=plus or minus
1.5%}) among persons living below the poverty level. However, among
persons with incomes below the poverty level, there were
substantial differences in smoking prevalence as measured by the
two question formats that included some-day smokers. As a result,
the combined prevalence estimate for 1992 was not significantly
different from the 1991 estimate.
Reported by: Surveillance Program, National Cancer Institute.
National Institutes of Health. Epidemiology Br, Office on Smoking
and Health, National Center for Chronic Disease Prevention and
Health Promotion; Div of Health Interview Statistics, National
Center for Health Statistics, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that the
estimated prevalence of smoking in 1992 was the same as in 1991
overall and for most demographic groups. In addition, these
findings indicate that including some-day smoking in the definition
of current smoking will increase the prevalence estimate by
approximately 1.0%. The definition used in the 1992 CES will become
the standard for CDC efforts to measure smoking prevalence in the
United States. The inclusion of intermittent smoking improves both
the accuracy and precision of the definition of current smoking and
facilitates efforts to monitor changes in current smoking status.

Based on use of the original definition of current smoker,
which did not assess some-day smoking, the prevalence of smoking in
1992 was significantly higher than in 1991 among persons living
below the poverty level. This finding was attributable to a
substantial increase in the prevalence of smoking among women who
live below the poverty level and to a smaller increase among men.
The impact of changes in the question format that incorporated an
assessment of some-day smoking substantially altered the prevalence
estimates for persons living below the poverty level. Specifically,
in the CCS survey -- which used a two-part question to assess
some-day smoking -- smoking prevalence increased among persons
living
below the poverty level. In comparison, in the CES survey -- which
used a single question to assess some-day smoking -- there was no
change in smoking prevalence.

For the first time since 1983, smoking prevalence among
persons aged 18-24 years did not decrease. Factors that may have
contributed to the stabilization include the steady growth in
market share of discount cigarettes (4) and the $4.6 billion in
advertising and promotional expenditures by tobacco companies
during 1991 -- a 16% increase in expenditures when compared with
1990
(5,6). Efforts to address smoking among young persons have included
the 1994 Surgeon General's report (6) and a companion report for
adolescents. In addition, CDC has published school guidelines for
incorporating tobacco-use prevention and tobacco-cessation
strategies (7).

The findings in this report are subject to at least two
limitations. First, the prevalence estimate for 1992 was based on
information collected from January through July 1992. In
comparison, a different survey that collected data for the entire
year indicated that smoking prevalence among adults declined in the
second half of the year (Substance Abuse and Mental Health Services
Administration, unpublished data, 1992), a finding consistent with
a 3% per capita decrease in consumption of cigarettes in 1992 (8).
Second, differences in prevalence among racial/ethnic groups may be
influenced by differences in educational levels and socioeconomic
status, as well as by social and cultural phenomena that require
further explanation.

Acceleration of the decline in smoking prevalence will require
intensified efforts to discourage the use of tobacco by helping
smokers break the addiction to nicotine, persuading children to
never initiate smoking, and enacting public policies that
discourage smoking. Examples of such policies include increasing
taxes on tobacco products, enforcing minors'-access laws,
restricting smoking in public places, and restricting tobacco
advertising and promotion. In January 1994, for the first time, all
50 states and the District of Columbia were receiving public funds
for tobacco-control activities: 49 states and the District of
Columbia were receiving federal funds, and California was receiving
state funds.

US Department of Health and Human Services. Preventing tobacco
use among young people: a report of the Surgeon General. Atlanta:
US Department of Health and Human Services, Public Health Service,
CDC, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health, 1994.

CDC. Guidelines for school health programs to prevent tobacco
use and addiction. MMWR 1994;43(no. RR-2).

Poverty statistics are based on definitions originated by the
Social Security Administration in 1964, subsequently modified by
federal interagency committees in 1969 and 1980, and prescribed by
the Office of Management and Budget as the standard to be used by
federal agencies for statistical purposes.

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